The chapter examines changes to social welfare policy, particularly the publicly funded health insurance component called Medicaid since the 1980s. Tools of executive federalism between national and state-level governments were used to increase state-level discretion over benefits allocation. The war on social welfare reached a zenith under the Clinton Administration, which among other things required work or training program participation to receive social assistance benefits. The Trump Administration has tried to adopt this strategy for Medicaid, based on its opposition to the allowed expansion of Medicaid-eligible populations under the Obama Administration’s Affordable Care Act initiative. As of June 2019, all of these state programs have been judicially blocked, responding to challenges that workfare does not fulfill the Medicaid requirement of improving clients’ health.
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